Grant Opportunity / SCBG
Name of Program
Funding Agency / IN State Dept. of Agriculture

Applicant Information

Lead (Legal ) Applicant

Organization
Chief Official (Name & Title)
Mailing Address
City / County
Zip+4 / Phone / Fax
E-Mail

Chief Financial Officer

Name & Title
Federal I.D./Tax Number
DUNS Number
CAGE/SAMS Code
CAGE Expiration Date:

Project Contact Person

Name & Title
Address / City
Zip+4 / Phone / Fax
E-Mail

Secondary Contact Person

Name & E-Mail
Grant Amount
Signature of Lead Applicant / Date

Applications must be submitted electronically (as a Microsoft Word Document) by May 1, 2015. Applications must be submitted by email to . Please reference guidance document for application instructions.

Organizational Bio:

Project Title (15 words or less)

Abstract:

Project Partner Organization - Include the name(s) of any organization partnering with lead agency.

Project Purpose

1. 

3. 

4. 

5. 

Potential Impact:

Expected Measurable Outcomes- Must use one of the forms referenced in guidance on page 11.

1.  GOAL:

·  Condensed version of goal stated above (for media release if program is chosen, 1-2 sentences):

2.  PERFORMANCE MEASURE:

3.  BENCHMARK:

4.  TARGET:

5.  PERFORMANCE MONITORING PLAN:

Work Plan:

Project Commitment:

Multi-State Projects:

Project Oversight:

Sustainability Plan:

Organizational Budget:

Budget:

Please either round all numbers up or not at all throughout budget reporting. Please refer to USDA Guideline Page 7 Section 5.3 to identify direct and indirect costs.

Budget Summary
Expense Category / Funds Requested
Personnel (salary only)
Travel
Equipment
Supplies
Contractual
Other
Direct Costs Subtotal
Indirect Costs (cannot exceed 8% of total budget)
Total Budget

·  Personnel- Calculate for two year period including fringe benefits

Name/Title / Level of Effort (# of hours OR % FTE) / Funds Requested

Please include budget narrative; also explain how fringe benefits were calculated:

Personnel Subtotal

·  Travel:

Trip Destination / Purpose of the Trip / Type of Expense (airfare, car rental, hotel, meals, mileage, etc.) / Unit of Measure (days, nights, miles) / Number of Units / Cost per Unit / Number of Travelers Claiming the Expense / Funds Requested
Travel Subtotal

Additional justification of travel expenses, as needed:

·  Equipment:

Item Description / Justification for Equipment / Rental or Purchase / Funds Requested
Equipment Subtotal

·  Supplies :

Item Description / Justification for Supplies / Per-Unit Cost / Number of Units/Pieces Purchased / Funds Requested
Supplies Subtotal

·  Contractual/Consultant:

Name / Services Provided / Reasoning / Hourly Rate / # of Hours

Additional verification and justification when applicable:

Contractual/Consultant Subtotal

·  Other :

Item Description / Justification of the Expense / Per-Unit Cost / Number of Units / Funds Requested
Other Subtotal

·  Program Income :

Source/Nature of Program Income / Description of how you will reinvest the program income into the project to solely enhance the competitiveness of specialty crops / Estimated Income
Program Income Total

·  Alternative Project Funding:

1